Champa’s eyes are surrounded by dark circles and her face is thin and drawn. It began with a fever, pain in her limbs, and she was then diagnosed with tuberculosis.

“I was diagnosed with TB two years ago now. I have been on medication but I am not getting any better. I have difficulty breathing and even talking is hard. It has been like this for five or six years – ever since the plant started, our problems have started too.”

Champa is not alone. She is one of millions of people in India whose health and lives are being blighted by the country’s surge in coal-based power generation.

170 gigawatts of new coal generation planned by 2022

India ranks third in the world in the production of carbon dioxide and is burning more coal than ever before, with 66% of power generated by coal-fired thermal power plants.

This is a colossal programme – equivalent to more than three times the UK’s entire peak power demand. It represents a response to an increasing population, a growing middle class hungry for modernity – and an energy policy that holds coal power as integral to the development of the country’s economy.

100,000 premature deaths a year

But as India pursues its aggressive path of coal-powered industrialisation, its leaders are showing themselves willing to sacrifice millions of people and huge swathes of the country to a dark and uncertain future.

According to the The Lancet’s Global Burden of Diseases Study outdoor air pollution – arising from power stations, other industry, transport, and domestic fuel burning for heat and cooking – is already among the top ten causes of death in India.

And while air quality and other environmental regulations do exist in India, they are rarely enforced. Sarath Guttikunda, chemical engineer and director at Urban Emissions New Delhi, believes them to be far weaker than in other countries:

“In India we do have ambient air quality standards … But what we have found is that these regulations lag behind the numbers that we have seen in Europe, United States and even in China, and there is a lot of room for improvement.”

In the first ever report focussing on the health impacts of the coal industry in India, scientists estimate that in 2011-2012, air pollution from coal-fired power plants alone was responsible for 80,000-115,000 premature deaths.

Diseases caused by the pollution include 20.9 million asthma attacks, bronchitis and other severe respiratory conditions, and cardiovascular disease. These health impacts are estimated to cost India $3.3 billion to $4.6 billion per year in medical expenses and lost work days.

India’s ‘energy capital’ – Singrauli

Singrauli, known as the “energy capital” of the country, is the industrial hub of north-central India. Straddling Uttar Pradesh and Madhya Pradesh, it produces 10% of the country’s coal-fired power.

Singrauli was once covered in forest and rich agricultural land, but the region’s coal lies underneath these forests, and they are being cleared at an alarming rate. Endangered species are pushed further towards extinction – and tribal communities are swept aside to make way for the energy juggernaut.

Priya Pillai, Senior Campaigner for Greenpeace India has worked in the area for over three years. “There are nine thermal power plants and eleven operational mines, and this is concentrated in one district. That’s the Singrauli region, and it’s because of this that you’ll find the large number of cases of asthma, of tuberculosis, of skin diseases, of cancer.”

Toxic dustbowls

The landscape is one of industrial devastation and critical levels of pollution, recently rated the third most polluted industrial cluster in the country by the comprehensive environmental pollution index. Air, water and soil have all been affected.

The open cast mines that scar the landscape resemble vast craters, streaked black with coal and trimmed green at the edges with what is left of the rapidly dwindling forest. Huge dump trucks and cranes appear miniature in the distance, barely visible through the poisonous haze.

Milky white stagnant ash ponds hold the by-product of the industry, fly ash. Black spiky stalks of dead foliage poke out of the sludge, testament to its toxicity.

Experts warn of acute health problems related to coal and the ash that it produces, conaining toxic heavy metals including mercury, arsenic, lead, nickel, barium and even radioactive substances such as uranium or thorium.

Man-made mountains of mining wastes, excavated and dumped, gradually bury entire villages. Coal-filled train bunkers and conveyor belts, some as long as 25km, snake from the mines to thermal power plants.

The towering stacks dominate the skyline, looming over settlements and pumping out smoke which can spread its pollution as far as 400 km away, choking communities below. The air is permanently clouded, limiting visibility. The smell and taste of coal dominate the senses.

Towering infernos

Chilika Dand, in the Sonebhadra district of Singrauli, Uttar Pradesh, is one of the most critically affected communities. The village of around 12,000 people is surrounded by multiple power plant stacks emitting putrid smoke, and overlooked by a fully operational open-cast mine just 50 meters away.

There is a constant industrial hum of engines revving and the scrape of metal on stone. Twice daily explosive blasts, and the subsequent patter and thud of debris, are more reminiscent of the sounds of war than of development. Few of the concrete rehabilitation blocks escape cracked walls due to tremors from the blasts.

A railway line and road are both dedicated to carrying coal. Villagers claim that at night, filters are removed from the stacks, and ash falls and settles on rooftops like toxic snow. Many of them have been moved, often forcibly, numerous times to make way for the industry that has destroyed their lives.

Manonit G Ravi, an activist and resident of Chilika Dand shouts over the noise of engines to make himself heard: “The entire village vibrates with the blasts. Sometimes they are so big and loud, people run out of their houses thinking there might be an earthquake.”

Sanitation is desperate, as the allocated plots leave little room for toilets. In summer, asphyxiating dust fills the air, and in winter and rainy seasons, there is a constant septic sludge underfoot. The smell, a mix of human and animal excrement, combined with acrid industrial pollution makes the air gritty, stinging eyes and making breathing a struggle.

Disease is rife

Residents of Chilika Dand say that illness and disease is rife in the community, with cancer, kidney failure, diabetes, vitiligo (the blanching of skin through pigment loss), hair loss and psychosis widespread.

These disease are all linked to contaminated water, coal ash, particles in the air, and the abnormally high levels of mercury present in the environment. Coal fired power stations are one of the main ways that mercury is released into the environment.

The World Health Organization states that even minimal exposure to mercury may cause health problems, including neurological damage to unborn fetuses and children. The heavy metal is considered “one of the top ten chemicals or groups of chemicals of major public health concern.”

Siraj Un Nissa, a resident of Chilika Dand and mother of eight has Vitiligo. Her hands, arms and mouth are blanched, and her whole body is patchy where pigment has been lost.

“I have been sick for the past eight years … The dust is making it hard for us to live here. No electricity. We get it for one hour and it’s gone. We don’t have a proper house to live in, just a makeshift shelter. We don’t have anything. No one cares about the poor.”

Buried under mine waste

Jharia, in neighbouring Madhya Pradesh, has almost disappeared. The remote village is being buried under waste from a nearby mine opened by Reliance in 2006.

A thin sliver of green and around 30% of the population is all that remains of this forest-dwelling community of Harijan people, squashed against a sheer, slowly encroaching, man-made cliff of debris.

Children sit quietly on top of huge boulders, the result of an avalanche, and push bikes loaded up with coal, which they have collected and bagged up for sale, one of the few ways they manage to survive.

Visibility is very limited through the dust-filled air, and the sound of a man chopping wood is intermittently drowned out as dump trucks rumble past, kicking up dust and adding to the mountainous pile of rock, where the village used to be.

It never used to be like this

Bandhu Saket, resident of Jharia explains how their health has been affected by the mine:”My youngest grandson gets so unwell, his teeth start chattering and his eyes enlarge, it feels like he will not get better …

“It never used to be like this. Ever since the companies have come, since the vehicles have been driving back and forth, since the blasting has started, illness and disease have been spreading.

“They dump things in all directions and when it is summertime, with all the dust, one cannot see anything so how can you expect anything else but to get sick!”

Bandhu explains that they used to have a well that provided drinking water to the village, but the company filled it in, and they are now forced to drink what they can. “Whatever we find in the drains or rainwater collected, that is what we drink.”

Manbasia, also from Jharia, is a mother of three. Supporting herself against a huge rock from the mine, she struggles to control the emotion in her voice, and speaks shakily of illness and disease in what is left of her community.

“I can’t see very well, my chest hurts, my feet don’t allow me to sit down or stand up … We have no one here to help or support us. If someone is dying, there is no one to look after them or save them. Who are we meant to turn to?”

Huge increases in mortality

Dr R. B. Singh has worked in the area for over 20 years, treating the local population in their homes, both in the small private practice that adjoins his home, and the Singrauli District Hospital next door.

A constant stream of patients waits outside his practice, all needing attention and treatment.

There has been a huge increase in death, sickness and disease “since the time the new industries have come here and the coal mine belt has progressed”, he insists.

“The patients we see in our new Out Patients Department present themselves with skin diseases and lung diseases, bronchitis, asthma and silicosis”, he explains. “And because of the contaminated drinking water, amebiasis and other abdominal ailments have increased.”

“I have come across bone cancer, mouth cancer, cervical cancer, breast cancer”, he adds.”All these are common here.” The bone cancers mostly occur in children, mouth cancers in adults.”

It’s a hospital – but where’s the medical equipment?

The District Hospital next door is in desperate need of facilities. A dilapidated shell with dark corridors, the maternity ward is splattered with blood and rainwater drips through cracks in the ceiling. A solitary brand new unit for premature babies looks oddly out of place.

There is no other medical equipment to be seen and a general sense of confusion and bewilderment prevails. Lights flicker on and off as the electricity supply fades in and out.

Wards are crowded but quiet, with beds full, people lying on the floor and an unmistakable shortage of staff. “We have a problem with a lack of doctors as most of them qualify and go abroad. They do not want to work in these small places”, says Dr Singh.

Hearts and lungs

Sarath Guttikunda, Director at Urban Emissions, New Delhi is a chemical engineer and air pollution expert. “When you are focusing on outdoor air pollution two things are really important – one is your lungs, and other is your heart.”

“Among the respiratory problems, the main one is asthma. People who are already suffering from asthma are obviously going to get affected even more, and children and older generation people – they are the ones that we see are getting affected the most.”

Ranjeet Singh, a primary school teacher in the area, says that sickness is rife in his pupils, with coughing and sneezing a constant sound in the classroom. Absenteeism is common due to ill health, and parents are deeply worried about their children.

“When I go to teach, there are 216 children. Out of those, if only 100 or 150 of them turn up, it makes us wonder why the children haven’t turned up.

“When we enquire, the child’s guardian tells us that their child has been unwell or that because we had to go to the hospital, they didn’t make it to school, or that for the past 15 days she’s been sick and lying in bed … These kind of problems come up a lot.”

A People betrayed

All over Singrauli, locals speak of sickness, their land and livelihoods being taken away, and promises of re-housing, education, employment and healthcare from the industry that haven’t materialized.

Rangeet Gupta is a local activist and youth worker living and working in the area. He says that after “persistent reminding”, the industry has not delivered the services that it promised.

The resultis that proper healthcare, among other things, is only available to people who can afford it, or those who work for the industry.

“In this area of ours, there isn’t even a decent hospital … for the displaced community. They have nothing at all, no schools, no doctors, no hospital, no roads, not even an arrangement for hygiene and sanitation. They have just been abandoned.”

Champa, like so many others, has experienced this first-hand, buying her own medicine when she has the money to do so, and going without treatment when she can’t afford it.

“We receive no help from the people at the plant at all. Since the health problems started because of the plant, we have not been given so much as a single tablet by them or the government.”

The future looks even worse

As the health epidemic gets more critical, scientists, medical professionals and campaigners all predict that if India pushes forward with the planned expansion, and regulations remain unenforced, the consequences to human life will be even more devastating.

According to Sarath Guttikunda, pollution from the power plants operating in the area has caused close to 100,000 premature deaths. “And if we are going to triple the number of power plants and don’t do anything about the regulations, we will at least triple this number.”

Doctor Singh warns that the atmosphere in Singrauli will be polluted “to such a degree that it will not be viable to live here anymore.” Champa, Manbasia and their families, along with hundreds of thousands of other people, face a future of poverty, sickness and death with no means of escape.

“Now, with the dust and smoke bellowing, there are people getting sick”, says Manbasia.”And if you don’t have the money, like us, what do we do? Kill ourselves?”